Excising portion of extensor carpi radialis brevis showed no benefit for chronic tennis elbow
Surgery that excises a portion of the extensor carpi radialis brevis, referred to as the Nirschl technique, provided no significant benefit to patients with chronic tennis elbow, according to a placebo-controlled study presented at the American Orthopaedic Society for Sports Medicine’s Specialty Day.
“We had significant improvements in both [placebo and experimental] groups, often starting in the 6-[week] to 12-week mark and improving further as time went on,” Martin Kroslak, MBBS, MSpMed, MSurg, said in his presentation. “There was no statistically significant difference between the groups at any timepoint in any outcome measure.”
The prospective, randomized, double-blind, placebo-controlled study included 26 patients who had tennis elbow for more than 6 months and failed at least two non-surgical modalities. Thirteen patients had surgery using the Nirschl technique and 13 patients received a sham procedure. Patient-rated frequency of elbow pain with activity 6 months after treatment was the primary outcome and secondary outcome measures included patient-rated frequency and severity of pain, functional outcomes, range of motion, epicondyle tenderness and strength at 6 months and approximately a year after surgery.
Both the placebo group and treatment group reported improved outcomes for pain frequency and severity, elbow stiffness, difficulty with picking up objects, twisting motions and overall elbow rating at 6 months and 1 year. Both groups also reported improved epicondyle tenderness, pronation-supination range and grip strength 6 months after surgery.
“We did a futility study at the end and it showed that for our primary outcome measure at 6 months, we would require over 6,500 patients in both groups to show a difference; and even if there was a difference, it would be trending toward the sham operation,” Kroslak said. “In conclusion, we have found that the surgical excision of the [extensor carpi radialis brevis] ECRB for patients with chronic tennis elbow offers no benefit over and above that of placebo surgery only.” – by Abbey Bigler
Kroslak M, et al. Paper #12. Presented at: the American Orthopaedic Society for Sports Medicine Specialty Day at the American Association for Orthopaedic Surgeons Annual Meeting; March 18, 2017; San Diego.